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Анестезия и интенсивная терапия у пациенток, получающих антикоагулянты

Приложение Г4

Оценка риска ВТЭО после родов (RCOG, 2015) [8]

Степень

Факторы Тактика

риска

– Любой предыдущий ВТЭО.

– Применение НМГ во время

– Обязательна тромбо-

беременности.

профилактика.

Высокий – НМГ не менее 6 недель.

– Тромбофилия высокого риска.

– Тромбофилия с низким риском +

– Эластическая

семейный анамнез ВТЭО

компрессия

–Кесарево сечение в родах.

–ИМТ 40 кг/м2.

–Релапаротомия и операция

( 3 дня) в послеродовом периоде.

– Любая операция в послеродовом

– Тромбопрофилактика

периоде, кроме непосредственного

НМГ в течение 10 суток

восстановления промежности.

NB, при сохранении

или > 3 факторов

– Сопутствующая патология, напри- Умеренный риска – продолжить

мер, рак, сердечная недостаточ-

ность, активная СКВ, воспалитель-

тромбопрофилактику

ные заболевания кишечника или

НМГ.

воспалительная полиартропатия,

– Эластическая

нефротический синдром, сахарный диабет I типа с нефропатией, серпо- видно-клеточная анемия, внутривенное употребление наркотиков

компрессия

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Анестезия и интенсивная терапия у пациенток, получающих антикоагулянты

Приложение Г5

Факторы риска для послеродовых ВТЭО (АССР, 2012) [2]

Высокие факторы риска: присутствие по крайней мере одного фактора риска предполагает риск послеродовых ВТЭО до 3%

–Неподвижность (строгий постельный режим в течение 1 недели).

–Послеродовое кровотечение 1000 мл и более с хирургическим вмешательством.

–Предыдущие ВТЭО.

–Преэклампсия с задержкой развития плода.

–Тромбофилия:

•дефицит антитромбина;

•фактор V Лейдена (гомозиготный или гетерозиготный);

•протромбин G20210A (гомозиготный или гетерозиготный).

–Медицинские условия:

•системная красная волчанка;

•заболевания сердца;

•серповидноклеточная анемия;

•переливание крови;

•послеродовая инфекция.

Незначительные факторы риска: присутствие, по крайней мере, двух факторов риска или одного фактора риска при экстренной операции кесарева сечения обусловливает риск послеродовых ВТЭО более 3%

–ИМТ > 30 кг/м2.

–Многоплодная беременность.

–Послеродовое кровотечение более 1000 мл.

–Курение более 10 сигарет в день.

–Задержка развития плода.

–Тромбофилия:

•дефицит протеина С;

•дефицит протеина S.

–Преэклампсия.

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Анестезия и интенсивная терапия у пациенток, получающих антикоагулянты

Приложение Г6

Тромбопрофилактика после предыдущего эпизода тромбоза у пациенток группы высокого риска [42]

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Анестезия и интенсивная терапия у пациенток, получающих антикоагулянты

Приложение Г7

Показатели системы гемостаза вне и во время беременности

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Анестезия и интенсивная терапия у пациенток, получающих антикоагулянты

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